| NPI | 1346793890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 273Y00000X Rehabilitation Unit (Licence: TX 117650) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX 117650) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2024-11-10 |